About the Health Plan

Simpra Advantage

Simpra Advantage (PPO I-SNP) or Simpra Advantage (PPO D-SNP) members receive more benefits than those covered by Original Medicare. Each member receives a personalized care plan, led by their Nurse-Practitioner and care team. There are two available plans: an Institutional Special Needs Plan (I-SNP) and a Dual-Eligible Special Needs Plan (D-SNP). Both plans cover all Medicare Part A and Part B benefits, plus Medicare Part D Prescription Drug Coverage and additional supplemental benefits. If you or your loved one is eligible, Simpra Advantage may be the extra benefit you need to enhance your well-being.

You have choices with Simpra Advantage

I-SNP

The Institutionalized Special Needs Plan (I-SNP) is for beneficiaries who have both Medicare Part A and Part B and live in a participating nursing facility. You must live or expect to live, as determined by the state, in a participating nursing facility for 90 days or more.

D-SNP

The Dual Eligible Special Needs Plan (D-SNP) is for beneficiaries who are eligible for both Medicare and Medicaid.

Membership Advantages

A Nurse Practitioner-led team who will coordinate your care and develop your care plan

24/7 member access to nurse practitioners while in a participating facility

Preventative services

Part D Prescription Drug Coverage

Nurse Practitioners will come to nursing facilities to provide treatment

Supplemental hearing, vision, and routine foot care benefits provided at no extra cost to you (varies with plan type selected)

Benefit Highlights

How much is the monthly premium?
$28.70 per month. In addition, you must keep paying your Medicare Part B premium.

How much is the deductible?
Part A Deductible: You pay the 2020 Original Medicare cost-sharing amounts. These are the 2020 cost sharing amounts and may change for 2021. Simpra Advantage (PPO I-SNP) will provide updated rates as soon as they are released:

You pay the 2020 Original Medicare cost-sharing amounts.
$1,408 deductible;
$0 copayment each day for days 1-60;
$352 copayment each day for days 61 to 90;
$704 copayment each day for days 91 to 150 (lifetime reserve days).

Part B deductible of $198.
$435 deductible per year for Part D prescription drugs.

Is there any limit on how much I will pay for my covered services?
Yes. Like all Medicare health plans, our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.
Your yearly limit(s) in this plan:

$6,700 for services you receive from in-network providers.

If you reach the limit on out-of-pocket costs, you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.
Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.

Is there a limit on how much the plan will pay?
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply

How much is the deductible?
Part A Deductible: You pay the 2020 Original Medicare cost-sharing amounts. These are the 2020 cost sharing amounts and may change for 2021. Simpra Advantage (PPO D-SNP) will provide updated rates as soon as they are released:

You pay the 2020 Original Medicare cost-sharing amounts.
$1,408 deductible;
$0 copayment each day for days 1-60;
$352 copayment each day for days 61 to 90;
$704 copayment each day for days 91 to 150 (lifetime reserve days).

Part B deductible of $198.
$435 per year for Part D prescription drugs.

Is there any limit on how much I will pay for my covered services?
Yes. Like all Medicare health plans, our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.
Your yearly limit(s) in this plan:

$6,700 for services you receive from in-network providers.

If you reach the limit on out-of-pocket costs, you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.
Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.

Is there a limit on how much the plan will pay?
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply

Simpra Advantage’s product offerings will focus on historically underserved individuals in Alabama who struggle to navigate the health care system and are less likely to get health care when they need it. The product offerings will utilize an interdisciplinary care team model which will focus on the goals of the individual member. Each enrolled member will have a personalized plan of care and coordination of medical services and social services. It is the goal of Simpra Advantage to develop a health care delivery system that can produce measurable improvement in the health status of enrolled members, while maintaining reasonable financial stability.

Want more information about Simpra Advantage?

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Phone

1-844-637-4770 (TTY 711)
Fax 1-800-547-6503

Mail

Simpra Advantage
PO Box 2190
Glen Allen, VA 23058

Notices & Disclaimers

Simpra Advantage is a PPO I-SNP and a PPO D-SNP with a Medicare contract. Enrollment in Simpra Advantage depends on contract renewal. Simpra Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.Every year, Medicare evaluates plans based on a 5-star rating system.